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Jayasena CN, de Silva NL, O'Reilly MW, MacKenzie F, Marrington R, Jones H, Livingston M, Downie P, Hackett G, Ramachandran S, Tomlinson J, David J, Boot C, Patel M, Tarling J, Wu F, Quinton R. Standardising the biochemical confirmation of adult male hypogonadism: A joint position statement by the Society for Endocrinology and Association of Clinical Biochemistry and Laboratory Medicine. Clin Endocrinol (Oxf) 2023. [PMID: 37393195 DOI: 10.1111/cen.14929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Inter-assay variation between different immunoassays and different mass spectrometry methods hampers the biochemical confirmation of male hypogonadism. Furthermore, some laboratories utilise assay manufacturer reference ranges that do not necessarily mirror assay performance characteristics, with the lower limit of normality ranging from 4.9 nmol/L to 11 nmol/L. The quality of the normative data underlying commercial immunoassay reference ranges is uncertain. DESIGN A working group reviewed published evidence and agreed upon standardised reporting guidance to augment total testosterone reports. RESULTS Evidence-based guidance on appropriate blood sampling, clinical action limits, and other major factors likely to affect the interpretation of results are provided. CONCLUSIONS This article aims to improve the quality of the interpretation of testosterone results by non-specialist clinicians. It also discusses approaches for assay harmonisation which have been successful in some but not all healthcare systems.
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Affiliation(s)
- Channa N Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Nipun L de Silva
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Michael W O'Reilly
- Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Finlay MacKenzie
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rachel Marrington
- Birmingham Quality (UK NEQAS), University Hospitals NHS Foundation Trust, Birmingham, UK
| | - Hugh Jones
- Department of Biochemistry, Royal Hallamshire Hospital, University of Sheffield Medical School, Sheffield, UK
| | - Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
- School of Medicine and Clinical Practice, Faculty of Science and Engineering, The University of Wolverhampton, Wolverhampton, UK
| | - Paul Downie
- Department of Clinical Biochemistry, Bristol Royal Infirmary, Bristol, UK
| | - Geoff Hackett
- Department of Urology, Spire Hospital, Birmingham, UK
| | - Sud Ramachandran
- Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Jeremy Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Janine David
- Department of Urology, Porthcawl Medical Centre, Princess of Wales Hospital, Bridgend, UK
| | - Christopher Boot
- Department of Blood Sciences, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Mayur Patel
- Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Julie Tarling
- Bedfordshire Hospitals NHS Foundation Trust, Bedfordshire, UK
| | - Fredrick Wu
- School of Medical Sciences, Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Quinton
- Department of Endocrinology, Diabetes and Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust & Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, UK
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2
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Clinical utility of laboratory developed mass spectrometry assays for steroid hormone testing. J Mass Spectrom Adv Clin Lab 2023; 28:13-19. [PMID: 36756146 PMCID: PMC9900367 DOI: 10.1016/j.jmsacl.2023.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Key Words
- ART, assisted reproductive technology
- CAP, College of American Pathologists
- CDC, Centers for Disease Control and Prevention
- CRP, C-reactive protein
- Endocrinology
- FDA, US Food and Drug Administration
- GC–MS, gas chromatography-mass spectrometry
- Immunoassay
- LC-MS/MS
- LC-MS/MS, liquid chromatography-tandem mass spectrometry
- Mass spectrometry
- NIST, National Institutes of Science and Technology
- RIA, radioimmunoassay
- RMP, Reference Measurement Procedure
- SRM, Standard Reference Material
- Sensitivity
- Specificity
- Steroid hormones
- VALID, Verifying Accurate Leading-edge IVCT Development Act of 2022
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Huang G, Bhasin S, Pencina K, Cheng M, Jasuja R. Circulating dihydrotestosterone, testosterone, and free testosterone levels and dihydrotestosterone-to-testosterone ratios in healthy women across the menstrual cycle. Fertil Steril 2022; 118:1150-1158. [PMID: 36371319 DOI: 10.1016/j.fertnstert.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To characterize the circulating androgen levels across the menstrual cycle in healthy women using highly sensitive and accurate methods and report sex differences in the relative levels of dihydrotestosterone (DHT) to testosterone (T) levels. DESIGN Prospective cohort study. SETTING Research clinic, academic teaching hospital. PATIENT(S) Twenty-one healthy premenopausal women, aged 19-40 years, with regular menstrual cycles. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Serum total T and DHT levels measured using liquid chromatography-tandem mass spectrometry, free T levels measured using a standardized equilibrium dialysis method coupled with measurement of the T levels in the dialysate using liquid chromatography-tandem mass spectrometry, and comparison of the DHT-to-T ratio between healthy women and age-matched healthy men. RESULT(S) The serum total and free T levels increased across the follicular phase and peaked at midcycle (total T, 43.6 ± 16.2 ng/dL; free T, 15.6 ± 11.9 pg/mL) and gradually declined in the luteal phase. The DHT level did not significantly change across the menstrual cycle. The DHT-to-T ratios were 1:4 and 1:13 in women and men, respectively. CONCLUSION(S) In healthy premenopausal women, the total and free T levels varied significantly across the menstrual cycle, whereas the DHT levels did not change; the peak total and free T levels in the midcycle period were higher than previously reported, underscoring the importance of establishing menstrual phase-specific reference ranges to avoid misdiagnosis of hyperandrogenism. Women have significantly higher DHT levels relative to total T than men; the significance of this sex difference in the DHT-to-T ratio needs further investigation.
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Affiliation(s)
- Grace Huang
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karol Pencina
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Cheng
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ravi Jasuja
- Research Program in Men's Health: Aging and Metabolism, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Baltodano-Calle MJ, Onton-Díaz M, Gonzales GF. Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review. Andrologia 2022; 54:e14561. [PMID: 35995581 DOI: 10.1111/and.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022] Open
Abstract
Sexual delinquency is a global problem where those with paraphilic disorders, such as paedophiles, are more likely to commit and reoffend. Androgen deprivation therapy (ADT) has been suggested as a solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for paraphilias. The importance of testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti-androgens, GnRH agonists and GnRH antagonists) and the effect of testosterone replacement therapy will be reviewed. The relationship between androgens, brain, sexual behaviour and pathophysiology of paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to androgens and a higher methylation state of the androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion, androgens represent a significant part of the pathophysiology of paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long-term ADT in paraphilic patients.
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Affiliation(s)
| | - Melisa Onton-Díaz
- Faculty of Medicine, Cayetano Heredia Peruvian University., Lima, Peru
| | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru
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Guzelce EC, Galbiati F, Goldman AL, Gattu AK, Basaria S, Bhasin S. Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders. Best Pract Res Clin Endocrinol Metab 2022; 36:101683. [PMID: 35927159 DOI: 10.1016/j.beem.2022.101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The circulating concentrations of total and free testosterone vary substantially in people over time due to biologic factors as well as due to measurement variation. Accurate measurement of total and free testosterone is essential for making the diagnosis of androgen disorders. Total testosterone should ideally be measured in a fasting state in the morning using a reliable assay, such as liquid chromatography tandem mass spectrometry, in a laboratory that is certified by an accuracy-based benchmark. Free testosterone levels should be measured in men in whom alterations in binding protein concentrations are suspected or in whom total testosterone levels are only slightly above or slightly below the lower limit of the normal male range for testosterone.
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Affiliation(s)
- Ezgi Caliskan Guzelce
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA
| | - Francesca Galbiati
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA
| | - Anna L Goldman
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA.
| | - Arijeet K Gattu
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA
| | - Shehzad Basaria
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA
| | - Shalender Bhasin
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA; Boston Claude D. Pepper Older Americans Independence Center, Boston, MA, USA
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